More kindergartners are getting vaccinated since a 2016 law signed by Gov. Jerry Brown mandating immunizations while banning personal beliefs exemptions.

However, there has been a slight uptick in medical exemptions as personal beliefs exemptions decrease, statewide and in Riverside County. While the increase is slight, the changing trend is cause for concern for Riverside County Public Health Officer Dr. Cameron Kaiser, who doesn’t know why it’s happening.

“I have great concern – either we have a greater number of kids entering the county with these (exemptible) medical issues, or we have a problem with the issuance of medical exemptions,” Kaiser said. “It’s going to be one or the other and either one is a problem.”

In the 2017-18 school year – 35,453 kindergartners were enrolled in schools throughout the county. Of that, nearly a half a percent had medical exemptions – about a 0.3 percent increase from 2015-16 when it was split with 0.2 percent having personal belief exemptions and 0.2 percent medical exemptions, Kaiser said.

“I think people need to realize vaccine-preventable illnesses are hardly a thing of the past,” Kaiser said. “Repeatedly, over and over we have seen demonstrations that even today, with the small amount of communicable disease that we have, vaccines are one of the most important public health interventions that we have ever introduced,” Kaiser said.

The trend is similar statewide, with 95.1 percent of kindergartners starting the 2017-18 school year having had their required immunizations for measles/mumps/rubella, diphtheria/tetanus/pertussis, Hepatitis B, polio and chickenpox – a 4.7 percent increase since the law went into effect in July 2016, the California Department of Public Health reports.

Medical exemptions must come from a licensed MD or DO and are issued for children with immune deficiencies or who may be undergoing medical treatment, such as chemotherapy for cancer, that weakens their immune system.

The Coachella Valley’s 50 elementary schools reported 90 to 99 percent of their kindergartners immunized in 2017-18 – with 37 of the campuses in the 97 to 99 percent range, not much different from three years ago.

“Riverside County has always done very well on vaccination rates … a testament to our county parents understanding what’s at stake and knowing the risks and benefits and choosing to vaccinate their children,” Kaiser said.

While the law – brought about by a 2014 measles outbreak linked to Disneyland – is resulting in more kids getting their shots, the issue of immunizations and whether they pose health risks to children remains an emotionally charged issue on both sides.

Talking to parents

Many parents are fearful of immunizations, even though the risks are minuscule, said Dr. Brian Murphy, a naturopathic doctor with Live Well Clinic in La Quinta.

The clinic specializes in healing through "natural" and intuitive methods.

Even so, Murphy said, there are no alternatives to immunizations and when parents come to him questioning whether they should vaccinate their children, he has them think about what they would do should their child contract a disease such as polio because they decided not to immunize.

Would they shrug it off and just accept it was the risk they took or would they wish they had gotten the child immunized?

“What would you say to yourself?” he asks them.

“Instead of me telling them what to do, I want parents to take an active role in their decisions,” Murphy said.

Social media does a lot to stoke the fears surrounding immunizations, Murphy and other doctors said.

“I still see plenty of conversation and dialog on social media that is polarizing and I’m not sure that is constructive,” Murphy said.

People need to study both sides of the issue, he said.

“I stress to parents, that if they are reading a lot of one perspective they need to look at others as well.”

Autism is still the most common area of concern, doctors said.

“In the 10 years before the measles vaccine was introduced in 1963, nearly all children got measles by the time they were 15 years old. An estimated that 3 million to 4 million children were infected each year.”

Centers for Disease Control and Prevention

It was a 1997 article published by British surgeon Andrew Wakefield, claiming a link between the measles, mumps, rubella – MMR – vaccine and autism that officials say has caused a scare among parents and caused many to seek exemptions.

That study has since been discredited and Wakefield stripped of his license to practice medicine.

“There is a lot of concern out there about autism … and I think that’s partly because we still don’t have a handle on all of the multi-factoral causes of autism but there is really good data to refute the fact that vaccines are tied to autism risk,” said Dr. Alexandra Clark, a pediatrician with Loma Linda University Medical Center.

Clark pointed to 1964-65 when there were 11,000 pregnancy miscarriages attributed to a rubella outbreak in the United States.

“Do we want to be so afraid of something that has no valid basis that we would be willing as a society to go back to an era that allowed epidemics of something you can control” through vaccines, Clark said.

“We should trust the data and know the disease is much worse than the vaccine,” she said. “To protect our children and our society from these diseases, then the responsible thing is to vaccinate, unless there’s a true medical reason not to.”

Herd immunity

The more who are vaccinated means those who can’t be immunized are protected as well by what is commonly called “herd immunity.”

Germs can travel quickly through a community and make a lot of people sick. If enough people get sick, it can lead to an outbreak. But when enough people are vaccinated against a certain disease, the germs can’t travel as easily from person to person — and the entire community is less likely to get the disease, according to the U.S. Department of Health and Human Services. That means even people who can’t get vaccinated will have some protection from getting sick. Eventually, the disease becomes rare — and sometimes, it’s wiped out altogether.

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Immunizations are up statewide three years after Gov. Jerry Brown signed a state law signed making them a requirement and prohibiting personal beliefs exemptions. However, the state has also seen a slight uptick in medical exemptions. Officials say immunizations don't benefit just the individual but all around and prevent outbreaks of childhood diseases, such as measles, chicken pox and mumps.(Photo11: Jay Calderon/The Desert Sun)

When 90 to 95 percent of a population is vaccinated against measles, for example, it weakens the odds for a breakout, Clark said.

The most recent measles outbreak was in 2014 and linked back to Disneyland.The country went from a low of 37 confirmed measles cased in 2004 to 667 in 2014 and that spike reflects a case of pockets of people not being vaccinated, having measles introduced to them by someone traveling internationally and then infecting those around them, Clark said.

“Over 90 percent of the (recent) outbreaks in the U.S. have all been linked to international travel. So, if you or your family member are not vaccinated and travel to somewhere in the world that doesn’t have the same amount of immunity regulations we have here … and you bring back measles to the U.S. and infect those around you who are not immunized … then we’re going to see a real spike in measles cases,” Clark said.

“The reason we did not have that spread to an even bigger epidemic (in 2014) is because we still had … enough people vaccinated to prevent it from spreading like ripples in a puddle spreading out and out and out,” Clark said.

While the flu vaccine is not required, Desert Sands Unified School District head nurse, Susan Frost, said students are encouraged to get them.

“The CDC and American Academy of Pediatrics recognize that influenza can have serious consequences for children at certain ages and with chronic health conditions,” Frost said.

Parents should talk with their chosen health practitioners about the advantage to their child of the annual flu shot, she said.

Regular reviews

Every year, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices reviews the schedule of immunizations, including flu vaccines, to see what is still needed and what may be eliminated because a disease has been fully eradicated.

In the 10 years before the measles vaccine was introduced in 1963, an estimated 3 million to 4 million children were infected with the disease each year. Also, each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized and 1,000 suffered encephalitis – swelling of the brain – from measles, according to the Centers for Disease Control and Prevention.(Photo11: ROBYN BECK / AFP/Getty Images file photo)

An example is the small pox vaccine which was stopped when the disease was eradicated worldwide.

“It’s not as though we pick an immunization schedule and leave it in stone,” Kaiser said.

“These things are regularly examined. We don’t want to be giving kids vaccines they don’t need, that’s just a waste of time and does expose them to a small additional risk – a risk without a benefit,” Kaiser said.

When parents come to their physician and state their concerns for health risks, what’s the best answer?

“The best answer is to acknowledge that they are not wrong. There are health risks associated with vaccines, it’s just they occur in such a small minority and the benefits of the vaccine … substantially outweigh any theoretical risk to them,” Kaiser said.

“There are health risks associated with vaccines, it’s just they occur in such a small minority and since the benefits of the vaccine … substantially outweigh any theoretical risk to them.”

Dr. Cameron Kaiser

Parents want good evidence to make the proper choice about immunizing their children and the key is for physicians to thoroughly explain the pros and cons.

“It’s important for us, as practitioners, to hear the parents and understand where they’re coming from and what their fears are. Some of their fears might have some validity, but many that the parents are bringing to us about vaccines are grounded in pop culture media; social media … non-medical substantiated sources. My job, as a pediatrician, is to have a conversation with the family to see if the concerns are valid,” Clark said.

The most common side effect of a vaccine is some muscle soreness or discomfort where the injection was given and some fever. Some children have allergic reactions but it is “very uncommon” to have a severe reaction, she said.

“But obviously, if a child has a fever and then has a febrile seizure as a result, that is absolutely scary to the family. But a febrile seizure is not lifelong dangerous to a child,” Clark said.

Studies have shown a small increased risk for febrile seizures in the first five to 12 days after a child has received their first MMR vaccine, the CDC reports.

“The risk is slightly higher with the measles, mumps, rubella, varicella – MMRV – combination vaccine, but the risk is still small,” The CDC reports. Studies have not shown an increased risk for febrile seizures after the separate varicella – chickenpox – vaccine.

Up to 5 percent of young children 6 months to 5 years old can experience febrile seizures at some time in their life. While they can be frightening, nearly all children who have a febrile seizure recover quickly and there is no permanent harm or lasting effects, the CDC states.

Deadly risks

Many who had measles or chickenpox and came through them without a problem may question the need to be vaccinated against such childhood diseases that were common at one time.

“It’s true, nearly everybody in the U.S. got measles before there was a vaccine and most people did fine,” Clark said. “But the reality is that people died from it every year.”

According to the CDC, in the 10 years before the measles vaccine was introduced in 1963, nearly all children got measles by the time they were 15 years old. An estimated that 3 million to 4 million children were infected each year.

“Also, each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized and 1,000 suffered encephalitis – swelling of the brain – from measles,” the CDC reports.

In 1978, the CDC set a goal to eliminate measles from the United States by 1982. While the goal was not met, widespread use of the measles vaccine “drastically reduced the disease rates.”

By 1981, the number of reported cases was 80 percent less than in 1980.

In 1989, however, an outbreak among vaccinated school-age children prompted the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians to recommend a second dose of MMR vaccine for all children.

There is also a risk of secondary illnesses from measles and other childhood diseases.

Measles is a virus and roughly one or two in every 1,000 children that contracts the disease may several years later develop measles encephalitis, which leads to convulsions, seizures, brain damage and even death, Clark said.

“We can’t predict which child will get that and which child will not,” Clark said. “If you have a son that gets mumps because he didn’t get the vaccine, we cannot predict who … will (develop) sterility and who will not,” Clark said.

“No parent is waking up today saying, ‘I hope I make a bad decision about the health of my child.’ They’re trying to make the best decision for their child.”

Dr. Alexandra Clark

The secondary complications of the infection “are beyond what we can control,” Clark said.

“I got chickenpox as a kid and I grew up in the era where parents would do a chickenpox party – if one kid on the block got chickenpox, you all went to get it because you just wanted to get it over with,” she said, laughing. “That’s what we did. I got chickenpox on my Christmas break.”

That was the thought process then and it was considered no big deal, because most kids came through it all fine. But the reality is, people died of chicken pox every year or they had to be hospitalized, incubated and spend time intensive care, she said.

“You can’t predict, as a parent, will that be your child or will your child be the one that gets sick and gets better. And, you have to decide the benefit ratio of that decision,” Clark said.

“No parent is waking up today saying, ‘I hope I make a bad decision about the health of my child.’ They’re trying to make the best decision for their child. But they’re hearing so many things from social media, from celebrities and potentially from their friends and family …,” Clark said.

It’s also true for pediatricians and physicians making the recommendations for vaccines.

“We’re trying to help families make the best decision for their child. We want that child to grow up health and to thrive,” Clark said.

Desert Sun reporter Sherry Barkas covers Tourism and Families. She can be reached at sherry.barkas@thedesertsun.com or (760) 778-4694. Follow her on Twitter @TDSSherryBarkas